Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care
Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care
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DOI：
10.2105/ajph.2014.302079
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发表时间：
2014-09-01
影响因子：
12.7
通讯作者：
Keating, Nancy L.
中科院分区：
文献类型：
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作者：
Samuel, Cleo A.;Landrum, Mary Beth;Keating, Nancy L.
目标。我们评估了退伍军人事务部(VA)卫生保健系统内的癌症护理差异，以及医院间的差异是否解释了差异。我们将退伍军人管理局的癌症登记数据与退伍军人管理局和医疗保险的管理数据联系起来，检查了2001-2004年间被诊断患有结直肠癌(n=12 897)、肺癌(n=25 608)或前列腺癌(n=38 202)的黑白退伍军人中的20项与癌症相关的质量指标。我们使用Logistic回归来评估每项指标的种族差异，并使用医院固定效应模型来确定差异是否可归因于医院内或医院内的差异。与白人相比，黑人早期结肠癌诊断率(调整后优势比[AOR]=0.80；95%可信区间[CI]=0.72，0.90)、I、II或III期直肠癌根治性手术(AOR=0.57；95%CI=0.41、0.78)、结肠癌3年生存率(AOR=0.75；95%CI=0.62、0.89)和直肠癌(AOR=0.61；95%CI=0.42，0.87；早期肺癌根治性手术(AOR=0.50；95%CI=0.41，0.60)；三维适形或调强放疗(3D-CRT/IMRT；AOR=0.53；95%CI=0.47，0.59)；高效止吐化疗(AOR=0.87；95%CI=0.78，0.98)。除3D-CRT/IMRT(AOR=0.75；95%CI=0.65，0.87)和强效止吐药(AOR=0.95；95%CI=0.82，1.10)外，医院固定效应的调整对种族差异的影响最小。在20项指标中有7项观察到VA癌症治疗方面的差异，这主要归因于医院内的差异。
Objectives. We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities.Methods. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12 897), lung (n = 25 608), or prostate (n = 38 202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between-or within-hospital differences.Results. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10).Conclusions. Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.